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B Dear Editor: b Advanced thyroid cancers may invade recurrent laryngeal nerve (RLN) through direct tumor extension or lymph node metastasis, resulting in vocal fold paralysis (VFP) which impacts patient's quality of life, affects the resectability when operating on the contralateral (functional) side due to the significant risk for bilateral VFP during surgery and the potential need for tracheotomy, and significantly impacts the surgical strategy.[1],[2] Many patients will be understandably hesitant to undergo surgery that involves permanent tracheotomy.[3] Both unilateral or bilateral VFP have a negative impact on a patient's quality of life and general health.[4],[5] While preoperative VFP is highly suggestive of RLN invasion, normal voice or laryngeal exam does not exclude RLN invasion at surgery. I BRAF SP V600E sp i mutations were detected in all seven patients (100%), I TERT i promoter mutations were detected in four patients (57.1%), I PIK3CA i mutations in two patients (28.6%), and I TP53 i mutations in two patients (28.6%), Supplementary Table S1. Overall, the median number of cycles of all neoadjuvant therapy received per patient regardless of therapy type was 4 cycles/patient. [Extracted from the article]

Background: Cytopathological evaluation of thyroid fine-needle aspiration biopsy (FNAB) specimens can fail to raise preoperative suspicion of medullary thyroid carcinoma (MTC). The Afirma RNA-sequencing MTC classifier identifies MTC among FNA samples that are cytologically indeterminate, suspicious, or malignant (Bethesda categories III–VI). In this study we report the development and clinical performance of this MTC classifier. Methods: Algorithm training was performed with a set of 483 FNAB specimens (21 MTC and 462 non-MTC). A support vector machine classifier was developed using 108 differentially expressed genes, which includes the 5 genes in the prior Afirma microarray-based MTC cassette. Results: The final MTC classifier was blindly tested on 211 preoperative FNAB specimens with subsequent surgical pathology, including 21 MTC and 190 non-MTC specimens from benign and malignant thyroid nodules independent from those used in training. The classifier had 100% sensitivity (21/21 MTC FNAB specimens correctly called positive; 95% confidence interval [CI] = 83.9–100%) and 100% specificity (190/190 non-MTC FNAs correctly called negative; CI = 98.1–100%). All positive samples had pathological confirmation of MTC, while all negative samples were negative for MTC on surgical pathology. Conclusions: The RNA-sequencing MTC classifier accurately identified MTC from preoperative thyroid nodule FNAB specimens in an independent validation cohort. This identification may facilitate an MTC-specific preoperative evaluation and resulting treatment. [ABSTRACT FROM AUTHOR]